ADOPT-A-STREET
VOLUNTEER TIME RECORD
Rev. 03/2018
Group Coordinator or crew leader: Have all Ambassadors or volunteers add their names and start/stop time
worked on this form and turn in with the equipment bag to City Hall no more than 3 days after your cleanup
event. Thank you for keeping Mukilteo beautiful and green!
Name of Your Group Name of Group Coordinator or crew leader
Date
Name of “Ambassador”
Hours Worked
Start time
End time
Total time worked
Please return the completed form after each litter cleanup to:
City of Mukilteo
Attn: Program Coordinator
11930 Cyrus Way
Mukilteo, WA 98275
aadoptastreet@mukilteowa.gov (425) 263-8018
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